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Q&A: Diagnosing and Treating Scoliosis

Thursday, December 13, 2018 10:58 AM

While uneven shoulders, hips or waists may just appear to be growing pains, they’re actually signs of something bigger; scoliosis. This condition, which usually appears in childhood or adolescence, can be associated with spinal abnormalities and neurological disorders, and if it goes untreated, it can cause chronic pain, pressure on the organs and increased curvature of the spine. Thankfully, advancements have allowed specialists like Dr. David Roberts, NorthShore Pediatric Orthopaedic Surgeon, to use innovative methods to successfully treat this condition.

Are there any exercises that will possibly help straighten out my curved spine?

Unfortunately, exercises do not correct or straighten out the spine. It is important to be wary of "miracle cures" - only surgery will straighten out the curvature for scoliosis in adults. However, most adults with scoliosis do not need this unless the curve is progressive, severe, and associated with significant pain and disability. However, keeping your back strong and flexible will help with your posture and can make it look better. In addition, exercises from a physical therapist can also relieve pain, and improve strength and flexibility for adults with scoliosis. We have a specialized program at NorthShore with therapists trained in the Schroth method, who do see adults as well as adolescents, and may be a good option to pursue.

At what degree of curvature lumbar area on a 16-year-old, would you consider surgery versus using a back brace to correct scoliosis?

Surgery is recommended for severe curves >50 degrees, or in some cases >45 degrees in children with significant growth remaining. Curves in this range have a high likelihood to get worse into adulthood, and hence why surgery is recommended. Bracing is best for curves 25-40 degrees, in children with growth remaining (pre-menarche or <6 months after onset of menses in girls). Bracing is not as effective for curves >40 degrees -- the curve may still progress even with the brace, but it can be tried in some cases. Some curves fall into a "gray zone" (40-50 degrees) where the curve is beyond typical criteria for bracing, but not yet severe enough to do surgery. For these, bracing can still be done (provided you are ok with lower chance of success), or the curve can be closely observed. Some curves stay in this safe range and may not need surgery. If there is progression, then surgery can be recommended as soon as it is indicated to ensure best results.

How are seniors (over age 65) affected by spinal-fusion surgery they've received as adolescents? Are there any symptoms/long term things to look out for?

Spinal instrumentation was developed in the 1960s, and modern techniques gained wider use in the 1980s (hooks) and 1990s (pedicle screws). Because of the stiffness of the fusion, there is a concern that this could put additional stress on the unaffected parts of the back, and lead to increased the risk of degenerative disc disease later in life. However, most patients do well life long, without any major issues. If a flare-up of back pain occurs, it is treated similarly to those without spinal fusion (e.g. physical therapy, exercises), and this is all that is needed for most patients with prior adolescent fusions into adulthood. We have early long-term research with 20-30 years out that confirms this. Keys to keeping your back healthy are regular exercise, especially core strengthening (yoga, pilates), maintaining a healthy weight, and avoiding smoking. These are all important for back health, and especially so with a prior fusion.

What are your thoughts on the use of botox injection to treat chronic pain? Any other thoughts on alternative treatments chronic pain (like yoga)?

I do not have a lot of experience with Botox for this use. I would probably start with physical therapy for core/abdomen strengthening, and back/hip stretching. Yoga or Pilates strengthen some of the same muscles, and are another option that can be tried on your own. I recommend this to most of my patients as part of good back health in adulthood.